"IV lidocaine already has been used in various surgical
settings without increasing adverse effects," Dr. So Yeon Kim
from Yonsei University College of Medicine, Seoul, Korea told
Reuters Health by email. "Therefore, there is no need for
hesitating use of IV lidocaine during ESD because the safety is
already proven. We recommend use of IV lidocaine as a bolus of
1.5 mg/kg and then as a continuous infusion of 2 mg/kg/h as
additional options for sedative drugs for ESD."

ESD is commonly used to treat premalignant lesions and early
stomach cancers, and several studies have reported methods for
reducing pain during and after the procedure.

Dr. Kim's team assessed the effects of IV lidocaine on
sedative and analgesic requirements during ESD and on post-ESD
pain in a randomized, placebo-controlled study of 66 patients
with early gastric neoplasm.

Sedation after propofol and fentanyl boluses occurred
significantly faster in the lidocaine group (median, 40 seconds)
than in the saline/placebo group (median, 55 seconds), according
to the May issue of Medicine.

The total dose of fentanyl during the procedure was 24%
lower and the total dose of propofol was 18% lower in the
lidocaine group than in the control group.

"ESD is performed under sedation, not under general
anesthesia; thus, it is important to maintain self-respiration
of patients during ESD," Dr. Kim explained. "Fentanyl and
propofol can induce respiratory depression; therefore, reducing
doses of these is more important in the setting of ESD than
surgery settings which are performed under general anesthesia."

Only 3% of patients in the lidocaine group had involuntary
movement during the procedure, compared with 26% of patients in
the control group.

Epigastric pain at 6 hours after ESD was rated significantly
lower by lidocaine patients than by control patients, and the
incidence of throat pain was also significantly lower in the
lidocaine group (27% vs 65%).

Complications after the procedure were similar between the
treatment groups, and there were no cardiovascular or
neurological side effects associated with IV lidocaine.

"We do not recommend routine use of lidocaine," Dr. Kim
said. "Instead we recommend (it) for patients with high risk of
respiratory depression (e.g., snoring history, obesity) or
procedure that takes longer time (because in this case high
doses of fentanyl and propofol are needed, which can result in
respiratory depression)."

Dr. Shinsuke Kiriyama from National Cancer Center Hospital,
Tokyo, Japan told Reuters Health by email, "Lidocaine has local
analgesic effect, so we use as local injection to gastric
submucosal layer, not intravenous."

Before using IV lidocaine during ESD, Dr. Kiriyama would
like to see "additional reports about effects and toxicity of
intravenous lidocaine using this method/setting."